The Affordable Care Act & Why We Still Need Private Care
By: Justin Farmer
It’s no secret that the Affordable Care Act (ACA) can be a nasty minefield for doctors in private practice to navigate. In the attempt to universalize healthcare and reduce costs generated by the ACA, the federal government incentivized physician clumping. Hospitals, Affordable Care Organizations (ACO’s), and private networks can more easily offset the accruing losses, pad that 90-day no-pay grace period, and afford the mandatory conversion to electronic medical records. So why, oh why would a physician want to remain in private care?
For all of those reasons just listed.
To explain, the ACA is designed with the sole purpose of extending the healthcare umbrella over those with pre-existing conditions or general poor health, providing healthcare for low-income patients, and cutting overall healthcare expenditures. These are all good things. However, these items all cost money – more money than can be offset by federal subsidies or a redistribution of contributed funds from high-income insurance customers. The result? Payments allotted to physicians are driven down.
The ACA claims that the increased insured-patient pool makes up for the difference, while ignoring the fact that time is a non-renewable resource. When a doctor’s schedule is full, the only way to increase earning power is to shorten the amount of time spent with each patient – something that doctors managed by a healthcare enterprise are forced to do.
This situation is compounded by the ACA’s new payment structures. Instead of paying per service rendered, the ACA saves money by paying per condition. The assumption is that this encourages more efficient use of healthcare resources and higher quality (over quantity) care. The downside is that those assumptions do not distinguish between poorly managed cases and complicated cases, or cases where the patients themselves are remiss (either intentionally or unintentionally) in their own healthcare maintenance. In all three scenarios, it is the healthcare entity that bears the cost, which it then transfers onto its doctors. Management and administration have to make profits too, after all.
In the case of primary care, this prevents holistic medicine (as this kind of thorough assessment takes time) and promotes more referrals. Healthcare as a system is evolving from a service industry to an industrial economy measured in inputs and outputs. Again, none of this is promoted intentionally by the ACA. Nonetheless, the results we are seeing are to be expected when the unit of measure is quantitative rather than qualitative.
In this environment, doctors have a choice: either join a larger organization and submit to the industrial complex or remain independent and self-managed. It is the same choice faced by many up and coming business professionals with a few caveats.
Remaining an independent physician will be hard work. Paperwork is increasing, (without a precedent of goodwill) online reviews are putting more emphasis on office décor and bedside manner than medical expertise, and insurance payments are sometimes more trouble than they’re worth. But while your finances might be lower and your hours sometimes longer, the perks of being your own boss are abundant.
Being put to the grindstone by higher management is generally referred to as ‘high demand, low control.’ Doing so without any perceived recognition or appreciation is called ‘high demand, low reward.’ Both of these conditions are linked to an at least two-fold increase in cardiovascular problems and risk of death from heart disease, and a significantly increased chance for obesity, anxiety, depression, or back and neck pain.
Being your own boss means freedom, flexibility and control over your own life: setting your own schedule, hiring your own staff, setting the rules and determining what kinds of patients you see (not to mention the tax breaks). It’s not a lifestyle for everyone, but if you’re an independent go-getter with a determination to provide excellent healthcare no matter what, private practice is by far the best way to go.